Costochondritis: chest wall pain, causes and what helps

Chest pain is frightening, and it should always be taken seriously. Once the heart and lungs have been ruled out, one of the most common causes is costochondritis, an irritation of the joints where the ribs meet the breastbone.

When is chest pain an emergency?

Call 000 immediately for chest pain or pressure that lasts more than a few minutes, or pain that spreads to your arm, shoulder, neck, jaw or back, especially with breathlessness, sweating, nausea, dizziness or feeling faint. Also call 000 for sudden sharp chest pain with shortness of breath, or coughing up blood. Don't drive yourself, and don't wait to see whether it passes. If you're not sure, treat it as an emergency.

What is costochondritis?

Costochondritis is inflammation or irritation of the cartilage joints connecting the ribs to the breastbone. A medical review describes it as a common condition that is usually benign and settles by itself, but which needs to be distinguished from more serious causes of chest pain (Proulx and Zryd, American Family Physician, 2009).

What does costochondritis feel like?

Typically a sharp, aching or pressure-like pain at the front of the chest, beside the breastbone, often on one side and affecting more than one rib. It's usually worse with deep breaths, coughing, sneezing, twisting, reaching and pressing on the area. Tenderness when you press on the joints is the key feature.

How do doctors tell it apart from heart pain?

Chest wall pain that's reproduced by pressing on the spot or by certain movements is more likely to be musculoskeletal. But tenderness alone doesn't rule out a heart problem: the same review notes that coronary artery disease is present in 3 to 6 per cent of adults with chest pain and chest wall tenderness. It recommends that people over 35, anyone with risk factors for heart disease, and anyone with heart or lung symptoms should have an ECG and possibly a chest X-ray. That's why new chest pain should be assessed by a doctor first.

What causes costochondritis?

Often there's no clear cause. Common triggers include a bout of heavy coughing, a chest infection, unaccustomed upper-body work, heavy bench press, dips or push-ups, a direct knock to the chest, and for grapplers, heavy chest pressure or being stacked. Stiffness in the upper back can also increase strain at the front of the rib cage.

How long does costochondritis last?

It usually settles over a few weeks, though some cases last several months and can come and go.

What helps costochondritis?

The review notes that clinical trials of treatment are lacking, and that usual practice is simple pain relief where safe, avoiding activities that strain the chest muscles, and reassurance. In practice, that means easing off heavy pressing, dips and anything that provokes the pain, using heat for comfort, and keeping gently mobile. Speak to your pharmacist or GP about suitable pain relief.

Can an osteopath help costochondritis?

Once a doctor has ruled out heart and lung causes, we can help with the musculoskeletal side. We assess the ribs, upper back, neck and shoulders, use gentle hands-on treatment to improve movement in the upper back and rib cage, and give you breathing and mobility exercises. We'll also guide your return to lifting or training.

Can I exercise with costochondritis?

Walking and lower-body exercise are usually fine. Avoid heavy pressing, dips, pull-ups and contact until pain with deep breathing and pressing on the area has settled, then reintroduce them gradually with lighter loads.

Is costochondritis the same as Tietze syndrome?

They're related but not identical. Tietze syndrome is a rarer condition that also involves the rib cartilage but comes with visible swelling over the joint, usually affecting a single upper rib. Costochondritis doesn't cause swelling and often involves several ribs.

Can anxiety cause chest wall pain?

Anxiety and stress can cause chest tightness and fast, shallow breathing, and can make chest wall pain feel worse. Worry about chest pain is understandable too. Having the heart and lungs checked by a doctor is the right first step, and often makes the pain much easier to manage.

How should I sleep with costochondritis?

Most people are more comfortable on their back or the unaffected side, slightly propped up. Hugging a pillow to your chest can support the area when you roll over or cough.

When should I go back to the doctor?

See your GP again if the pain changes, gets worse, isn't improving after a few weeks, or comes with fever, a productive cough, breathlessness, or swelling and redness over the area. Any new chest pain that feels different from your usual pain needs medical assessment.

See our posts on rib joint dysfunction, rib injuries in BJJ and pain between the shoulder blades, or our upper back pain guide. Book an assessment at our Berwick clinic. A 60-minute initial consultation is $149, with no referral needed and HICAPS on-site.

Sources

Proulx AM, Zryd TW. Costochondritis: diagnosis and treatment. American Family Physician, 2009.

Book an initial consultation at RISE Sports & Spinal in Berwick. Clear diagnosis, hands-on treatment, and a plan that actually gets you better.

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